I’m very excited about these data; I think that they really demonstrate that the power of the immune system to recognise and destroy malignant melanoma is going to change the treatment for patients with this disease.
Of course ipi is the standard, would you ideally mix nivolumab and ipi or would you use one then the other? There are lots of options, aren’t there?
One of the wonderful things about having multiple active treatments for a disease such as melanoma is we now have to learn how to use the treatments in the best possible way.
One of the exciting challenges we face in the field is now that we have multiple active agents is how to use them best. So the question is do we use them in sequence, do we use them individually, where do we use them together?
What the Hodi paper shows is that if you combine ipilimumab targeting CTLA4 with the anti-PD1 antibody nivolumab you get much improved outcomes compared to the use of ipilimumab alone.
So if you were going to recommend doctors at this point, obviously there’s a licensing question coming up, but what’s it looking like at the moment? Combinations to the fore?
It appears right now that if you use combinations of those two agents that will be more effective than using ipilimumab alone.
So one could imagine that in the future that combination will be preferable to treatment with ipilimumab alone.
What’s not yet know is whether using nivolumab, the anti-PD1 antibody, first followed by the combination only if patients are not benefitting from the PD1 antibody will turn out to be an alternate strategy that can yield improved outcomes.